Combination therapy with apilimod and glutamatergic agents

ABSTRACT

Provided are compositions and methods related to the use of apilimod in combination with glutamatergic agents for treating neurological diseases and disorders, and for the treatment of cancer.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of priority from U.S. ProvisionalApplication Ser. No. 62/633,335, filed on Feb. 21, 2018, the contents ofwhich are hereby incorporated herein by reference in their entirety.

FIELD OF THE DISCLOSURE

The present disclosure relates to compositions and methods comprisingapilimod for use in combination with glutamatergic agents in thetreatment of neurological diseases and disorders, and cancer.

BACKGROUND OF THE DISCLOSURE

Apilimod, also referred to as STA-5326, hereinafter “apilimod”, isrecognized as a potent transcriptional inhibitor of IL-12 and IL-23. Seee.g., Wada et al. Blood 109 (2007): 1156-1164. IL-12 and IL-23 areinflammatory cytokines normally produced by immune cells, such asB-cells and macrophages, in response to antigenic stimulation.Autoimmune disorders and other disorders characterized by chronicinflammation are characterized in part by inappropriate production ofthese cytokines. In immune cells, the selective inhibition ofIL-12/IL-23 transcription by apilimod was recently shown to be mediatedby apilimod's direct binding to phosphatidylinositol-3-phosphate5-kinase (PIKfyve). See, e.g., Cai et al. Chemistry and Biol. 20(2013):912-921. PIKfyve plays a role in Toll-like receptor signaling,which is important in innate immunity.

Some neurodegenerative diseases result in the accumulation of proteinaggregates or other intermediates of cellular catabolism that may leadto neural toxicity and degeneration.

Glutamate, also referred to as glutamic acid, is the main excitatoryneurotransmitter in humans. It is also a substrate in the synthesis ofthe main inhibitory neurotransmitter, GABA (γ-Aminobutyric acid), whichregulates neuronal excitability.

Glutamate transporters are a family of neurotransmitter transporterproteins that move glutamate across neural cell membranes. Glutamatetransporters include two main classes, the excitatory amino acidtransporters and the vesicular glutamate transporters. The amino acidtransporters remove glutamate from the synaptic cleft by stimulatingreuptake into neural cells. The vesicular transporters move glutamateintracellularly from the cell cytoplasm into synaptic vesicles.

Glutamate excitotoxicity refers to a pathological process by whichneural cells are damaged or destroyed by excessive glutamatestimulation. High levels of glutamate cause the over-stimulation ofglutamate receptors such as the N-methyl-D-aspartate (NMDA) and AMPAreceptors, setting in motion the pathological activation of variousintracellular enzymes that results in damage to cellular structuresincluding the cytoskeleton, membranes, and even DNA.

Glutamate excitotoxicity is implicated in various neurological diseasesand disorders including spinal cord injury, stroke, and traumatic braininjury, as well as in certain neurodegenerative diseases of the centralnervous system including multiple sclerosis, Alzheimer's disease,amyotrophic lateral sclerosis (ALS), Parkinson's disease, alcoholism oralcohol withdrawal and Huntington's disease.

SUMMARY OF THE DISCLOSURE

The present disclosure provides methods for treating a neurologicaldisease or disorder and methods for treating cancer in a subject in needthereof, the method comprising administering to the subject apharmaceutical composition comprising apilimod, or a pharmaceuticallyacceptable salt thereof, in combination with a glutamatergic agent.

In embodiments, the disclosure provides a method for treating aneurological disease or disorder in a subject in need thereof, themethod comprising administering to the subject a pharmaceuticalcomposition comprising apilimod, or a pharmaceutically acceptable saltthereof, in combination with a glutamatergic agent. In embodiments, theapilimod is apilimod dimesylate. In embodiments, the glutamatergic agentis selected from a glutamate transporter modulating agent and aglutamate receptor antagonist. In embodiments, the glutamate transportermodulating agent is an excitatory amino acid reuptake inhibitor. Inembodiments, the glutamate receptor antagonist is anN-methyl-D-aspartate (NMDA) receptor antagonist. In embodiments, theglutamate receptor antagonist is selected from AP5(R-2-amino-5-phosphonopentanoate), AP7 (2-amino-7-phosphonoheptanoicacid), CNQX (6-cyano-7-nitroquinoxaline-2,3-dione), CPPene(3-[(R)-2-carboxypiperazin-4-yl]-prop-2-enyl-1-phosphonic acid), NBQX(2,3-dihydroxy-6-nitro-7-sulfamoyl-benzo[f]quinoxaline-2,3-dione), andselfotel (CGS-19755). In embodiments, the glutamate receptor antagonistis selected from amantadine, atomoxetine, AZD6765, agmatine,gacyclidine, ketamine, memantine, eliprodil, delucemin. In embodiments,the glutamatergic agent is selected from BHV-5000, lamotrigine,lanicemine, riluzole, trigriluzole, and topiramate. In embodiments, thepharmaceutical composition is an oral dosage form or a sublingual dosageform. In embodiments, the glutamatergic agent is administered in thesame or a different dosage form as the apilimod.

In embodiments, the neurological disease or disorder is selected fromAlzheimer's disease, amyotrophic lateral sclerosis (ALS), attentiondeficit hyperactivity disorder, autism, cerebellar ataxia,Charcot-Marie-Tooth disease, Creutzfeldt-Jakob disease, dementia,epilepsy, Friedreich's ataxia, Huntington's disease, multiple sclerosis,obsessive compulsive disorder (OCD), Parkinson's disease, Rett syndrome,senile chorea, spinal ataxia, spinal cord injury, supranuclear palsy,traumatic brain injury.

In embodiments, the neurological disease or disorder is dementia. Inembodiments, the dementia is selected from AIDS dementia complex (ADC),dementia associated with Alzheimer's disease (AD), dementia pugilistica,diffuse Lewy body disease, frontotemporal dementia, mixed dementia,senile dementia of Lewy body type, and vascular dementia.

In certain embodiments for the treatment of frontotemporal dementia orALS, the patient in need of treatment of is one having repeat expansionsin the C9ORF72 gene.

In embodiments, the neurological disease or disorder is amyotrophiclateral sclerosis (ALS).

In embodiments, the neurological disease or disorder is Rett syndrome.

In embodiments, the neurological disease or disorder is obsessivecompulsive disorder (OCD).

In embodiments, the subject is human.

The disclosure also provides a method for treating amyotrophic lateralsclerosis (ALS) in a subject in need thereof, the method comprisingadministering to the subject a pharmaceutical composition comprisingapilimod, or a pharmaceutically acceptable salt thereof, in combinationwith a glutamatergic agent selected from riluzole and trigriluzole.

The disclosure also provides a method for treating Alzheimer's diseasein a subject in need thereof, the method comprising administering to thesubject a pharmaceutical composition comprising apilimod, or apharmaceutically acceptable salt thereof, in combination with aglutamatergic agent selected from riluzole and trigriluzole.

The disclosure also provides a method for treating obsessive compulsivedisorder (OCD) in a subject in need thereof, the method comprisingadministering to the subject a pharmaceutical composition comprisingapilimod, or a pharmaceutically acceptable salt thereof, in combinationwith a glutamatergic agent selected from riluzole and trigriluzole.

The disclosure also provides a method for treating Rett syndrome in asubject in need thereof, the method comprising administering to thesubject a pharmaceutical composition comprising apilimod, or apharmaceutically acceptable salt thereof, in combination with aglutamatergic agent selected from BHV-5000, and lanicemine.

The disclosure also provides a method of treating cancer in a subject inneed thereof, the methods comprising administering to the subject apharmaceutical composition comprising apilimod, or a pharmaceuticallyacceptable salt thereof, in combination with a glutamatergic agentselected from riluzole and trigriluzole, preferably trigriluzole. Inembodiments, the cancer is selected from brain cancer, breast cancer,cervical cancer, colorectal cancer, leukemia, lung cancer, lymphoma,melanoma or other skin cancer, ovarian cancer, prostate cancer, renalcancer, and testicular cancer.

The disclosure also provides a pharmaceutical composition comprisingapilimod for use in combination therapy with a glutamatergic agent inthe treatment of a neurological disease or disorder, or for thetreatment of cancer. In embodiments, the apilimod is apilimoddimesylate. In embodiments, the glutamatergic agent is selected from aglutamate transporter modulating agent and a glutamate receptorantagonist. In embodiments, the glutamate transporter modulating agentis an excitatory amino acid reuptake inhibitor. In embodiments, theglutamate receptor antagonist is an N-methyl-D-aspartate (NMDA) receptorantagonist. In embodiments, the glutamate receptor antagonist isselected from amantadine, atomoxetine, AZD6765, agmatine, gacyclidine,memantine, eliprodil, delucemin. In embodiments, the glutamatergic agentis selected from riluzole, trigriluzole, BHV-5000, and lanicemine. Inembodiments, the apilimod and the glutamatergic agent are contained inthe same dosage form.

In embodiments, the pharmaceutical composition is for use in treating aneurological disease or disorder selected from Alzheimer's disease,amyotrophic lateral sclerosis (ALS), attention deficit hyperactivitydisorder, autism, cerebellar ataxia, Charcot-Marie-Tooth disease,Creutzfeldt-Jakob disease, dementia, epilepsy, Friedreich's ataxia,Huntington's disease, multiple sclerosis, obsessive compulsive disorder(OCD), Parkinson's disease, Rett syndrome, senile chorea, spinal ataxia,spinal cord injury, supranuclear palsy, and traumatic brain injury. Inembodiments, the neurological disease or disorder is dementia. Inembodiments, the dementia is selected from AIDS dementia complex (ADC),dementia associated with Alzheimer's disease (AD), dementia pugilistica,diffuse Lewy body disease, frontotemporal dementia, mixed dementia,senile dementia of Lewy body type, and vascular dementia. Inembodiments, the neurological disease or disorder is amyotrophic lateralsclerosis (ALS). In embodiments, the neurological disease or disorder isRett syndrome. In embodiments, the neurological disease or disorder isobsessive compulsive disorder (OCD)

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1: Fold change of plasma (shed) GPNMB after 14 days of dosingbetween pre-dose and day 15 in 12 patients. The fold change for eachpatient is indicated parentheses in the key in the upper right corner ofthe graph.

DETAILED DESCRIPTION OF THE DISCLOSURE

The present disclosure provides compositions and methods related to theuse of apilimod for treating neurological diseases and disorders, andcancer, particularly in combination with modulators of the glutamatetransporter/receptor system. Accordingly, the disclosure providesmethods for treating a neurological disease or disorder and methods fortreating cancer in a subject in need thereof, comprising administeringapilimod, or a pharmaceutically acceptable salt thereof, in combinationwith a glutamatergic agent.

The term “apilimod” refers to2-[2-Pyridin-2-yl)-ethoxy]-4-N′-(3-methyl-benzilidene)-hydrazino]-6-(morpholin-4-yl)-pyrimidine(IUPAC name:(E)-4-(6-(2-(3-methylbenzylidene)hydrazinyl)-2-(2-(pyridin-2-yl)ethoxy)pyrimidin-4-yl)morpholine),represented by Formula I:

The CAS number of apilimod is 541550-19-0.

Apilimod can be prepared, for example, according to the methodsdescribed in U.S. Pat. Nos. 7,923,557, and 7,863,270, and WO2006/128129.

In embodiments of the compositions and methods described here, apharmaceutically acceptable salt, solvate, clathrate, hydrate,polymorph, metabolite, prodrug, analog or derivative of apilimod may beused in the compositions and methods for treating a neurological diseaseor disorder.

The term “pharmaceutically acceptable salt,” is a salt formed from, forexample, an acid and a basic group of a compound described herein (e.g.,2-[2-Pyridin-2-yl)-ethoxy]-4-N′-(3-methyl-benzilidene)-hydrazino]-6-(morpholin-4-yl)-pyrimidine).Illustrative salts include, but are not limited, to sulfate, citrate,acetate, oxalate, chloride, bromide, iodide, nitrate, bisulfate,phosphate, acid phosphate, isonicotinate, lactate, salicylate, acidcitrate, tartrate, oleate, tannate, pantothenate, bitartrate, ascorbate,succinate, maleate, besylate, gentisinate, fumarate, gluconate,glucaronate, saccharate, formate, benzoate, glutamate, methanesulfonate,ethanesulfonate, benzenesulfonate, p-toluenesulfonate, and pamoate(e.g., 1,1′-methylene-bis-(2-hydroxy-3-naphthoate)) salts. In apreferred embodiment, the salt of apilimod comprises methanesulfonate.The term “pharmaceutically acceptable salt” also refers to a saltprepared from a compound described herein (e.g.,2-[2-Pyridin-2-yl)-ethoxy]-4-N′-(3-methyl-benzilidene)-hydrazino]-6-(morpholin-4-yl)-pyrimidine),having an acidic functional group, such as a carboxylic acid functionalgroup, and a pharmaceutically acceptable inorganic or organic base.

Suitable bases include, but are not limited to, hydroxides of alkalimetals such as sodium, potassium, and lithium; hydroxides of alkalineearth metal such as calcium and magnesium; hydroxides of other metals,such as aluminum and zinc; ammonia, and organic amines, such asunsubstituted or hydroxy-substituted mono-, di-, or trialkylamines;dicyclohexylamine; tributyl amine; pyridine; N-methyl, N-ethylamine;diethylamine; triethylamine; mono-, bis-, or tris-(2-hydroxy-lower alkylamines), such as mono-, bis-, or tris-(2-hydroxyethyl)amine,2-hydroxy-tert-butylamine, or tris-(hydroxymethyl)methylamine, N,N-di-lower alkyl-N-(hydroxy lower alkyl)-amines, such asN,N-dimethyl-N-(2-hydroxyethyl)amine, or tri-(2-hydroxyethyl)amine;N-methyl-D-glucamine; and amino acids such as arginine, lysine, and thelike. The term “pharmaceutically acceptable salt” also refers to a saltprepared from a compound described herein (e.g.,2-[2-Pyridin-2-yl)-ethoxy]-4-N′-(3-methyl-benzilidene)-hydrazino]-6-(morpholin-4-yl)-pyrimidine),having a basic functional group, such as an amino functional group, anda pharmaceutically acceptable inorganic or organic acid. Suitable acidsinclude hydrogen sulfate, citric acid, acetic acid, oxalic acid,hydrochloric acid (HCl), hydrogen bromide (HBr), hydrogen iodide (HI),nitric acid, hydrogen bisulfide, phosphoric acid, lactic acid, salicylicacid, tartaric acid, bitartratic acid, ascorbic acid, succinic acid,maleic acid, besylic acid, fumaric acid, gluconic acid, glucaronic acid,formic acid, benzoic acid, glutamic acid, methanesulfonic acid,ethanesulfonic acid, benzenesulfonic acid, and p-toluenesulfonic acid.

The salts of the compounds described herein (e.g.,2-[2-Pyridin-2-yl)-ethoxy]-4-N′-(3-methyl-benzilidene)-hydrazino]-6-(morpholin-4-yl)-pyrimidine)can be synthesized from the parent compound (e.g.,2-[2-Pyridin-2-yl)-ethoxy]-4-N′-(3-methyl-benzilidene)-hydrazino]-6-(morpholin-4-yl)-pyrimidine)by conventional chemical methods such as methods described inPharmaceutical Salts: Properties, Selection, and Use, P. Hemrich Stalil(Editor), Camille G. Wermuth (Editor), ISBN: 3-90639-026-8, August 2002.Generally, such salts can be prepared by reacting the parent compound(e.g.,2-[2-Pyridin-2-yl)-ethoxy]-4-N′-(3-methyl-benzilidene)-hydrazino]-6-(morpholin-4-yl)-pyrimidine)with the appropriate acid in water or in an organic solvent, or in amixture of the two.

One salt form of a compound described herein (e.g.,2-[2-Pyridin-2-yl)-ethoxy]-4-N′-(3-methyl-benzilidene)-hydrazino]-6-(morpholin-4-yl)-pyrimidine)can be converted to the free base and optionally to another salt form bymethods well known to the skilled person. For example, the free base canbe formed by passing the salt solution through a column containing anamine stationary phase (e.g. a Strata-NH₂ column). Alternatively, asolution of the salt in water can be treated with sodium bicarbonate todecompose the salt and precipitate out the free base. The free base maythen be combined with another acid using routine methods.

The term “polymorph” means solid crystalline forms of a compound of thepresent disclosure (e.g.,2-[2-Pyridin-2-yl)-ethoxy]-4-N′-(3-methyl-benzilidene)-hydrazino]-6-(morpholin-4-yl)-pyrimidine)or complex thereof. Different polymorphs of the same compound canexhibit different physical, chemical and/or spectroscopic properties.Different physical properties include, but are not limited to stability(e.g., to heat or light), compressibility and density (important informulation and product manufacturing), and dissolution rates (which canaffect bioavailability). Differences in stability can result fromchanges in chemical reactivity (e.g., differential oxidation, such thata dosage form discolors more rapidly when comprised of one polymorphthan when comprised of another polymorph) or mechanical characteristics(e.g., tablets crumble on storage as a kinetically favored polymorphconverts to thermodynamically more stable polymorph) or both (e.g.,tablets of one polymorph are more susceptible to breakdown at highhumidity). Different physical properties of polymorphs can affect theirprocessing. For example, one polymorph might be more likely to formsolvates or might be more difficult to filter or wash free of impuritiesthan another due to, for example, the shape or size distribution ofparticles of it.

The term “hydrate” means a compound of the present disclosure (e.g.,2-[2-Pyridin-2-yl)-ethoxy]-4-N′-(3-methyl-benzilidene)-hydrazino]-6-(morpholin-4-yl)-pyrimidine)or a salt thereof, which further includes a stoichiometric ornon-stoichiometric amount of water bound by non-covalent intermolecularforces.

The term “clathrate” means a compound of the present disclosure (e.g.,2-[2-Pyridin-2-yl)-ethoxy]-4-N′-(3-methyl-benzilidene)-hydrazino]-6-(morpholin-4-yl)-pyrimidine)or a salt thereof in the form of a crystal lattice that contains spaces(e.g., channels) that have a guest molecule (e.g., a solvent or water)trapped within.

The term “prodrug” means a derivative of a compound described herein(e.g.,2-[2-Pyridin-2-yl)-ethoxy]-4-N′-(3-methyl-benzilidene)-hydrazino]-6-(morpholin-4-yl)-pyrimidine)that can hydrolyze, oxidize, or otherwise react under biologicalconditions (in vitro or in vivo) to provide a compound of thedisclosure. Prodrugs may only become active upon such reaction underbiological conditions, or they may have activity in their unreactedforms. Examples of prodrugs contemplated in this disclosure include, butare not limited to, analogs or derivatives of a compound describedherein (e.g.,2-[2-Pyridin-2-yl)-ethoxy]-4-N′-(3-methyl-benzilidene)-hydrazino]-6-(morpholin-4-yl)-pyrimidine)that comprise biohydrolyzable moieties such as biohydrolyzable amides,biohydrolyzable esters, biohydrolyzable carbamates, biohydrolyzablecarbonates, biohydrolyzable ureides, and biohydrolyzable phosphateanalogues. Other examples of prodrugs include derivatives of compoundsof any one of the formulae disclosed herein that comprise —NO, —NO₂,—ONO, or —ONO₂ moieties. Prodrugs can typically be prepared usingwell-known methods, such as those described by Burger's MedicinalChemistry and Drug Discovery (1995) 172-178, 949-982 (Manfred E. Wolffed., 5th ed).

In addition, some of the compounds suitable for use in the methods of inthis disclosure (e.g.,2-[2-Pyridin-2-yl)-ethoxy]-4-N′-(3-methyl-benzilidene)-hydrazino]-6-(morpholin-4-yl)-pyrimidine)have one or more double bonds, or one or more asymmetric centers. Suchcompounds can occur as racemates, racemic mixtures, single enantiomers,individual diastereomers, diastereomeric mixtures, and cis- or trans- orE- or Z-double isomeric forms. All such isomeric forms of thesecompounds are expressly included in the present disclosure. Thecompounds of this disclosure (e.g.,2-[2-Pyridin-2-yl)-ethoxy]-4-N′-(3-methyl-benzilidene)-hydrazino]-6-(morpholin-4-yl)-pyrimidine)can also be represented in multiple tautomeric forms, in such instances,the disclosure expressly includes all tautomeric forms of the compoundsdescribed herein (e.g., there may be a rapid equilibrium of multiplestructural forms of a compound), the disclosure expressly includes allsuch reaction products). All such isomeric forms of such compounds areexpressly included in the present disclosure. All crystal forms of thecompounds described herein (e.g.,2-[2-Pyridin-2-yl)-ethoxy]-4-N′-(3-methyl-benzilidene)-hydrazino]-6-(morpholin-4-yl)-pyrimidine)are expressly included in the present disclosure.

The term “solvate” or “pharmaceutically acceptable solvate,” is asolvate formed from the association of one or more solvent molecules toone of the compounds disclosed herein (e.g.,2-[2-Pyridin-2-yl)-ethoxy]-4-N′-(3-methyl-benzilidene)-hydrazino]-6-(morpholin-4-yl)-pyrimidine).The term solvate includes hydrates (e.g., hemi-hydrate, mono-hydrate,dihydrate, trihydrate, tetrahydrate, and the like).

The term “analog” refers to a chemical compound that is structurallysimilar to another but differs slightly in composition (as in thereplacement of one atom by an atom of a different element or in thepresence of a particular functional group, or the replacement of onefunctional group by another functional group). Thus, an analog is acompound that is similar or comparable in function and appearance, butnot in structure or origin to the reference compound. As used herein,the term “derivative” refers to compounds that have a common corestructure, and are substituted with various groups as described herein.

In certain embodiments of the disclosure described herein, apilimod, ora pharmaceutically acceptable salt, hydrate, clathrate, or prodrug ofapilimod, as described above, may be provided in combination with one ormore additional therapeutic agents. In accordance with any of theseembodiments, the apilimod, or a pharmaceutically acceptable salt,solvate, clathrate, hydrate, polymorph, metabolite, prodrug, analog orderivative thereof, may be provided in the same dosage form as the oneor more additional therapeutic agents, or in a separate dosage form.

Methods of Treatment

The present disclosure provides methods for treating a neurologicaldisease or disorder, or a cancer, in a subject in need thereofcomprising administering apilimod, or a pharmaceutically acceptablesalt, solvate, clathrate, hydrate, polymorph, metabolite, prodrug,analog or derivative thereof, in combination with a glutamatergic agent.The present disclosure further provides the use of apilimod, or apharmaceutically acceptable salt, solvate, clathrate, hydrate,polymorph, metabolite, prodrug, analog or derivative thereof, incombination with a glutamatergic agent for the preparation of amedicament useful for the treatment of a neurological disease ordisorder, or a cancer.

In embodiments, the glutamatergic agent is selected from a glutamatetransporter modulating agent and a glutamate receptor antagonist. Inembodiments, the glutamate transporter modulating agent is an excitatoryamino acid reuptake inhibitor. In embodiments, the glutamate receptorantagonist is an N-methyl-D-aspartate (NMDA) receptor antagonist. Inembodiments, the glutamate receptor antagonist is an antagonist of theα-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPA)receptor, or the kainite receptor.

In embodiments, the glutamatergic agent is a glutamate receptorantagonist selected from AP5 (R-2-amino-5-phosphonopentanoate), AP7(2-amino-7-phosphonoheptanoic acid), CNQX(6-cyano-7-nitroquinoxaline-2,3-dione), CPPene(3-[(R)-2-carboxypiperazin-4-yl]-prop-2-enyl-1-phosphonic acid), NBQX(2,3-dihydroxy-6-nitro-7-sulfamoyl-benzo[f]quinoxaline-2,3-dione), andselfotel (CGS-19755).

In embodiments, the glutamatergic agent is a glutamate receptorantagonist selected from amantadine, atomoxetine, AZD6765, agmatine,gacyclidine, ketamine, memantine, eliprodil, delucemin.

In embodiments, the glutamatergic agent is selected from BHV-5000,lamotrigine, lanicemine, riluzole, trigriluzole, and topiramate.

The methods described here relate to combination therapy with apilimodand at least one glutamatergic agent. The terms, “combination therapy”or “co-therapy” include the administration of a compound describedherein, e.g., apilimod, or a pharmaceutically acceptable salt, solvate,clathrate, hydrate, polymorph, metabolite, prodrug, analog or derivativethereof, with at least one additional agent, e.g., a glutamatergicagent, as part of a specific treatment regimen intended to provide abeneficial effect from the co-action of these compounds. The beneficialeffect may result in the slowing of the progression of the neurologicaldisease or disorder, or the cancer, and/or the alleviation of one ormore symptoms of the neurological disease or disorder, or the cancer.The beneficial effect of the combination includes, but is not limitedto, pharmacokinetic or pharmacodynamic co-action resulting from thecombination. The beneficial effect of the combination may also relate tothe mitigation of a toxicity, side effect, or adverse event associatedwith another agent in the combination. “Combination therapy” is notintended to encompass the administration of two or more of thesetherapeutic compounds as part of separate monotherapy regimens thatincidentally and arbitrarily result in the combinations of the presentdisclosure.

In the context of combination therapy, administration of apilimod, or apharmaceutically acceptable salt, solvate, clathrate, hydrate,polymorph, metabolite, prodrug, analog or derivative thereof, may besimultaneous with or sequential to the administration of theglutamatergic agent. In another aspect, administration of the differentcomponents of a combination therapy may be at different frequencies. Theone or more additional agents may be administered prior to (e.g., 5minutes, 15 minutes, 30 minutes, 45 minutes, 1 hour, 2 hours, 4 hours, 6hours, 12 hours, 24 hours, 48 hours, 72 hours, 96 hours, 1 week, 2weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 8 weeks, or 12 weeks before),concomitantly with, or subsequent to (e.g., 5 minutes, 15 minutes, 30minutes, 45 minutes, 1 hour, 2 hours, 4 hours, 6 hours, 12 hours, 24hours, 48 hours, 72 hours, 96 hours, 1 week, 2 weeks, 3 weeks, 4 weeks,5 weeks, 6 weeks, 8 weeks, or 12 weeks after) the administration of acompound of the present disclosure.

The therapeutic agents can be formulated for co-administration in asingle dosage form, or they can be administered separately in differentdosage forms. When administered separately, administration may be by thesame or a different route of administration for each of the componentsof the combination therapy.

Preferably, combination therapy provides a synergistic response. Theterm “synergistic” refers to the efficacy of the combination being morethan the additive effects of either single therapy alone. Thesynergistic effect of combination therapy may permit the use of lowerdosages and/or less frequent administration of at least one agent in thecombination compared to its dose and/or frequency outside of thecombination. The synergistic effect may also be manifested in theavoidance or reduction of adverse or unwanted side effects associatedwith the use of either therapy in the combination alone.

In embodiments of the methods described herein, apilimod, or apharmaceutically acceptable salt, solvate, clathrate, hydrate,polymorph, metabolite, prodrug, analog or derivative thereof, may beadministered at the same time or at a different time, the context of thecombination therapy with the glutamatergic agent. In embodiments, theapilimod, or a pharmaceutically acceptable salt, solvate, clathrate,hydrate, polymorph, metabolite, prodrug, analog or derivative thereof,and the glutamatergic agent are administered in a single dosage form, orin separate dosage forms.

In embodiments, the combination therapy with apilimod and aglutamatergic agent further includes an additional agent that mitigatesone or more side effects of apilimod, for example, nausea, vomiting,headache, dizziness, lightheadedness, drowsiness and stress. In oneaspect of this embodiment, the additional agent is a serotonin receptorantagonist, also known as 5-hydroxytryptamine receptors or 5-HTreceptors. In one aspect, the additional agent is an antagonist of a5-HT₃ or 5-HT_(1a) receptor. In one aspect, the agent is selected fromthe group consisting of ondansetron, granisetron, dolasetron andpalonosetron. In another aspect, the agent is selected from the groupconsisting of pindolol and risperidone.

In accordance with the methods described here, the neurological diseaseor disorder may be selected from a neurodegenerative disease ordisorder, epilepsy, a neuromuscular disorder, or a neurodevelopmentaldisorder.

Neurodegenerative diseases and disorders that may be treated accordingto the methods described here include, for example, Alzheimer's disease(AD), amyotrophic lateral sclerosis (ALS), diffuse Lewy body disease,motor neuron diseases, multiple sclerosis (MS), Parkinson's disease(PD), Friedreich's ataxia, prion disease, spinocerebellar ataxia (SCA),and spinal muscular atrophy (SMA). Other, less common neurodegenerativediseases and disorders that may be treated include, for example,Creutzfeldt-Jakob disease (CJD), progressive supranuclear palsy (PSP,Steele-Richardson-Olszewski syndrome), senile chorea, Huntington'sChorea, spinal ataxia including spinocerebellar ataxia (SCA),Friedreich's ataxia, Subacute sclerosing panencephalitis, frontotemporallobar degeneration, and Hallerrorden-Spatz disease (Pantothenatekinase-associated neurodegeneration, PKAN). In an embodiment for thetreatment of ALS or frontotemporal dementia, the patient in need oftreatment of is one having repeat expansions in the C9ORF72 gene.

Various forms of dementia may also be considered neurodegenerativediseases. In general, the term ‘dementia’ describes a group of symptomsaffecting memory, thinking and social abilities severely enough tointerfere with daily functioning. Accordingly, the disclosure alsoprovides methods of treating dementia, including AIDS dementia complex(ADC), dementia associated with Alzheimer's disease (AD), dementiapugilistica, diffuse Lewy body disease, frontotemporal dementia, mixeddementia, senile dementia of Lewy body type, and vascular dementia. Inan embodiment for the treatment of frontotemporal dementia, the patientin need of treatment of is one having repeat expansions in the C9ORF72gene.

Neuromuscular disorders that may be treated according to the methodsdescribed here include, for example, infantile spinal muscular atrophy(SMA1, Werdnig-Hoffmann disease), and juvenile spinal muscular atrophy(SMA3, Kugelberg-Welander disease).

Neurodevelopmental disorders that may be treated according to themethods described here include Rett syndrome.

In accordance with the methods described here, the neurological diseaseor disorder may also be selected from bipolar disorder, treatmentresistant and major depression, general anxiety disorder, panicdisorder, social anxiety, mood disorders, cognitive disorders,agitation, apathy, psychoses, post-traumatic stress disorders,irritability, disinhibition, learning disorders, memory loss,personality disorders, bipolar disorders, eating disorders, conductdisorder, pain disorders, delirium, drug addiction, tinnitus, mentalretardation, cervical spondylotic myelopathy, spinal cord injury,hereditary cerebellar ataxia, Tourette syndrome, autism spectrumdisorder, schizophrenia, fragile X syndrome, Parkinson's Disease andHuntington's disease.

In embodiments for the treatment of Alzheimer's disease, the combinationtherapy with apilimod and a glutamatergic agent may form part of atherapeutic regimen including administration of a cholinesteraseinhibitor (e.g., Aricept™, Exelon™, Razadyne™). In an embodiment for thetreatment of Alzheimer's disease, the glutamatergic agent is selectedfrom memantine (Namenda™) and trigriluzole.

In embodiments for the treatment of amyotrophic lateral sclerosis (ALS),the combination therapy with apilimod and a glutamatergic agent may formpart of a therapeutic regimen including administration of anantioxidant, such as edaravone (Radicava™, Radicut™). In an embodimentfor the treatment of ALS, the glutamatergic agent is selected fromriluzole and trigriluzole. In an embodiment for the treatment of ALS,the glutamatergic agent is trigriluzole. In an embodiment for thetreatment of ALS, the patient in need of treatment of is one havingrepeat expansions in the C9ORF72 gene.

In embodiments for the treatment of obsessive compulsive disorder (OCD),the combination therapy with apilimod and a glutamatergic agent may formpart of a therapeutic regimen including administration of a selectiveserotonin reuptake inhibitor (SSRI), clomipramine, or an atypicalantipsychotic such as risperidone. In an embodiment for the treatment ofALS, the glutamatergic agent is selected from riluzole and trigriluzole.

In embodiments for the treatment of Rett syndrome, the combinationtherapy with apilimod and a glutamatergic agent may form part of atherapeutic regimen including administration of a selective serotoninreuptake inhibitor (SSRI). In an embodiment for the treatment of Rettsyndrome, the glutamatergic agent is selected from BHV-5000 andlanicemine.

In embodiments, the disclosure provides a method of treating aneurological disease or disorder selected from stroke, Alzheimer'sdisease, Parkinson's disease, schizophrenia, epilepsy and chronic painin a subject in need thereof, the method comprising administering to thesubject a pharmaceutical composition comprising apilimod, or apharmaceutically acceptable salt thereof, optionally apilimoddimesylate, in combination with a glutamatergic agent, optionallyselected from agmatine, amantadine, AP5(R-2-amino-5-phosphonopentanoate), eliprodil, and selfotel.

In embodiments, the disclosure provides a method of treating aneurological syndrome or anxiety-related disorder in a subject in needthereof, the method comprising administering to the subject apharmaceutical composition comprising apilimod, or a pharmaceuticallyacceptable salt thereof, optionally apilimod dimesylate, in combinationwith a glutamatergic agent, optionally selected from AP7(2-amino-7-phosphonoheptanoic acid) and agmatine.

In embodiments, the disclosure provides a method of treating epilepsy orneuropathic pain in a subject in need thereof, the method comprisingadministering to the subject a pharmaceutical composition comprisingapilimod, or a pharmaceutically acceptable salt thereof, optionallyapilimod dimesylate, in combination with a glutamatergic agent,optionally selected from CPPene(3-[(R)-2-carboxypiperazin-4-yl]-prop-2-enyl-1-phosphonic acid), NBQX(2,3-dihydroxy-6-nitro-7-sulfamoyl-benzo[f]quinoxaline-2,3-dione), andselfotel.

In embodiments, the disclosure provides a method of treating Parkinson'sdisease, Parkinsonism syndrome, or multiple sclerosis in a subject inneed thereof, the method comprising administering to the subject apharmaceutical composition comprising apilimod, or a pharmaceuticallyacceptable salt thereof, optionally apilimod dimesylate, in combinationwith a glutamatergic agent, optionally amantadine.

In embodiments, the disclosure provides a method of treating attentiondeficit hyperactivity disorder (ADHD) in a subject in need thereof, themethod comprising administering to the subject a pharmaceuticalcomposition comprising apilimod, or a pharmaceutically acceptable saltthereof, optionally apilimod dimesylate, in combination with aglutamatergic agent, optionally atomoxetine.

In embodiments, the disclosure provides a method of treating depressionin a subject in need thereof, the method comprising administering to thesubject a pharmaceutical composition comprising apilimod, or apharmaceutically acceptable salt thereof, optionally apilimoddimesylate, in combination with a glutamatergic agent, optionallyselected from agmatine, delucemin, and lanicemine.

In embodiments, the disclosure provides a method of treating cancer in asubject in need thereof, the methods comprising administering to thesubject a pharmaceutical composition comprising apilimod, or apharmaceutically acceptable salt thereof, optionally apilimoddimesylate, in combination with a glutamatergic agent. In embodiments,the cancer expresses the metabotropic glutamate receptor 1 (GRM1). Inembodiments, the cancer is an inoperable or metastatic advanced solidtumor or a lymphoma. In embodiments, the cancer is selected from braincancer (including glioma and glioblastoma), breast cancer, cervicalcancer, colorectal cancer, leukemia, lung cancer, lymphoma, melanoma orother skin cancer, ovarian cancer, prostate cancer, renal cancer, andtesticular cancer. In embodiments, the cancer is melanoma or breastcancer. In embodiments, the glutamatergic agent is selected from aglutamate transporter modulating agent and a glutamate receptorantagonist. In embodiments, the glutamate transporter modulating agentis an excitatory amino acid reuptake inhibitor. In embodiments, theglutamate receptor antagonist is an N-methyl-D-aspartate (NMDA) receptorantagonist. In embodiments, the glutamate receptor antagonist isselected from AP5 (R-2-amino-5-phosphonopentanoate), AP7(2-amino-7-phosphonoheptanoic acid), CNQX(6-cyano-7-nitroquinoxaline-2,3-dione), CPPene(3-[(R)-2-carboxypiperazin-4-yl]-prop-2-enyl-1-phosphonic acid), NBQX(2,3-dihydroxy-6-nitro-7-sulfamoyl-benzo[f]quinoxaline-2,3-dione), andselfotel (CGS-19755). In embodiments, the glutamate receptor antagonistis selected from amantadine, atomoxetine, AZD6765, agmatine,gacyclidine, ketamine, memantine, eliprodil, delucemin. In embodiments,the glutamatergic agent is selected from BHV-5000, lamotrigine,lanicemine, riluzole, trigriluzole, and topiramate. In embodiments, theglutamatergic agent is trigriluzole.

A “subject in need thereof” refers to a subject in need of treatment fora neurological disease or disorder, or a cancer. In embodiments, thesubject in need is one that is “non-responsive” or “refractory” to astandard therapy for the neurological disease or disorder, or thecancer. In this context, the terms “non-responsive” and “refractory”refer to the subject's response to therapy as not clinically adequate torelieve one or more symptoms associated with the neurological disease ordisorder, or the cancer. In embodiments, the patient in need oftreatment of is one having repeat expansions in the C9ORF72 gene, forexample, in embodiments relating to a neurological disease or disorder,especially ALS or frontotemporal dementia.

A “subject” refers generally to a mammal. The mammal can be e.g., ahuman, primate, mouse, rat, dog, cat, cow, horse, goat, camel, sheep ora pig. Preferably, the subject is a human. The terms “subject” and“patient” are used interchangeably herein.

The terms, “treatment”, “treating” or “treat” describes the managementand care of a subject having a neurological disease or disorder, or acancer, as described here and includes the administration of atherapeutic agent, or combination thereof as described here, to slow theprogression of the disease or disorder and/or to alleviate one or moresymptoms of the neurological disease or disorder, or the cancer. In thiscontext, treating includes administering an amount of the therapeuticagent, or combination of agents, effective to alleviate one or moresymptoms of the neurological disease or disorder, or the cancer. Theterm “alleviate” refers to a process by which the severity of a symptomis reduced or decreased, but it may not necessarily be eliminated,although it may be eliminated for a period of time, or temporarily.While elimination of the symptom is preferred, it is not required. Theterms, “prevention”, “preventing” or “prevent” refer to reducing oreliminating the onset of a symptom, especially in the context ofpreventing the progression of the disease or disorder, or the cancer,where progression is defined by the onset one or more symptoms.

The term “therapeutically effective amount” refers to an amountsufficient to treat, ameliorate a symptom of, reduce the severity of, orreduce the duration of the neurological disease or disorder, or thecancer, or to enhance or improve the therapeutic effect of anothertherapy. The precise effective amount for a subject will depend upon thesubject's body weight, size, and health; the nature and extent of thecondition; and the therapeutic or combination of therapeutics selectedfor administration.

An effective amount of apilimod can be administered once daily, from twoto five times daily, up to two times or up to three times daily, or upto eight times daily. In embodiments, the apilimod is administeredthrice daily, twice daily, once daily, fourteen days on (four timesdaily, thrice daily or twice daily, or once daily) and 7 days off in a3-week cycle, up to five or seven days on (four times daily, thricedaily or twice daily, or once daily) and 14-16 days off in 3 week cycle,or once every two days, or once a week, or once every 2 weeks, or onceevery 3 weeks.

An effective amount of apilimod, or a pharmaceutically acceptable salt,solvate, clathrate, hydrate, polymorph, metabolite, prodrug, analog orderivative thereof, can range from about 0.001 mg/kg to about 1000mg/kg, more preferably 0.01 mg/kg to about 100 mg/kg, more preferably0.1 mg/kg to about 10 mg/kg; or any range in which the low end of therange is any amount between 0.001 mg/kg and 900 mg/kg and the upper endof the range is any amount between 0.1 mg/kg and 1000 mg/kg (e.g., 0.005mg/kg and 200 mg/kg, 0.5 mg/kg and 20 mg/kg). Effective doses will alsovary, as recognized by those skilled in the art, depending on thediseases treated, route of administration, excipient usage, and thepossibility of co-usage with other therapeutic treatments such as use ofother agents. See, e.g., U.S. Pat. No. 7,863,270, incorporated herein byreference.

In more specific aspects, apilimod or a pharmaceutically acceptablesalt, solvate, clathrate, hydrate, polymorph, metabolite, prodrug,analog or derivative thereof, is administered at a dosage regimen of30-300 mg/day (e.g., 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90,95, 100, 125, 150, 175, 200, 225, 250, 275, or 300 mg/day) for at least1 week (e.g., 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 36, 48, or moreweeks). Preferably, a compound of the disclosure is administered at adosage regimen of 100-300 mg/day for 4 or 16 weeks. Alternatively orsubsequently, a compound of the disclosure is administered at a dosageregimen of 100 mg twice a day for 8 weeks, or optionally, for 52 weeks.

Pharmaceutical Compositions and Formulations

The disclosure provides pharmaceutical compositions comprising apilimod,or a pharmaceutically acceptable salt, solvate, clathrate, hydrate,polymorph, metabolite, prodrug, analog or derivative thereof, for use incombination therapy with a glutamatergic agent in the treatment of aneurological disease or disorder, or in the treatment of cancer.

The disclosure also provides pharmaceutical compositions comprising anamount of apilimod, or a pharmaceutically acceptable salt, solvate,clathrate, hydrate, polymorph, metabolite, prodrug, analog or derivativethereof, in combination with a glutamatergic agent and, optionally, atleast one pharmaceutically acceptable excipient or carrier, wherein theamount is effective for the treatment of a neurological disease ordisorder, or a cancer.

In embodiments, the apilimod, or a pharmaceutically acceptable salt,solvate, clathrate, hydrate, polymorph, metabolite, prodrug, analog orderivative thereof, is combined with a glutamatergic agent in a singledosage form. In embodiments, the pharmaceutical composition furthercomprises an antioxidant.

A “pharmaceutical composition” is a formulation containing one or moretherapeutic agents in a pharmaceutically acceptable form suitable foradministration to a subject. The term “pharmaceutically acceptable”refers to those compounds, materials, compositions, carriers, and/ordosage forms which are, within the scope of sound medical judgment,suitable for use in contact with the tissues of human beings and animalswithout excessive toxicity, irritation, allergic response, or otherproblem or complication, commensurate with a reasonable benefit/riskratio.

“Pharmaceutically acceptable excipient” means an excipient that isuseful in preparing a pharmaceutical composition that is generally safe,non-toxic and neither biologically nor otherwise undesirable, andincludes excipient that is acceptable for veterinary use as well ashuman pharmaceutical use. Examples of pharmaceutically acceptableexcipients include, without limitation, sterile liquids, water, bufferedsaline, ethanol, polyol (for example, glycerol, propylene glycol, liquidpolyethylene glycol and the like), oils, detergents, suspending agents,carbohydrates (e.g., glucose, lactose, sucrose or dextran), antioxidants(e.g., ascorbic acid or glutathione), chelating agents, low molecularweight proteins, or suitable mixtures thereof.

A pharmaceutical composition can be provided in bulk or in dosage unitform. It is especially advantageous to formulate pharmaceuticalcompositions in dosage unit form for ease of administration anduniformity of dosage. The term “dosage unit form” as used herein refersto physically discrete units suited as unitary dosages for the subjectto be treated; each unit containing a predetermined quantity of activecompound calculated to produce the desired therapeutic effect inassociation with the required pharmaceutical carrier. The specificationfor the dosage unit forms of the disclosure are dictated by and directlydependent on the unique characteristics of the active compound and theparticular therapeutic effect to be achieved. A dosage unit form can bean ampoule, a vial, a suppository, a dragee, a tablet, a capsule, an IVbag, or a single pump on an aerosol inhaler.

In therapeutic applications, the dosages vary depending on the agent,the age, weight, and clinical condition of the recipient patient, andthe experience and judgment of the clinician or practitioneradministering the therapy, among other factors affecting the selecteddosage. Generally, the dose should be a therapeutically effectiveamount. Dosages can be provided in mg/kg/day units of measurement (whichdose may be adjusted for the patient's weight in kg, body surface areain m², and age in years). An effective amount of a pharmaceuticalcomposition is that which provides an objectively identifiableimprovement as noted by the clinician or other qualified observer. Forexample, alleviating a symptom of a disorder, disease or condition. Asused herein, the term “dosage effective manner” refers to amount of apharmaceutical composition to produce the desired biological effect in asubject or cell.

For example, the dosage unit form can comprise 1 nanogram to 2milligrams, or 0.1 milligrams to 2 grams; or from 10 milligrams to 1gram, or from 50 milligrams to 500 milligrams or from 1 microgram to 20milligrams; or from 1 microgram to 10 milligrams; or from 0.1 milligramsto 2 milligrams.

The pharmaceutical compositions can take any suitable form (e.g,liquids, aerosols, solutions, inhalants, mists, sprays; or solids,powders, ointments, pastes, creams, lotions, gels, patches and the like)for administration by any desired route (e.g, pulmonary, inhalation,intranasal, oral, buccal, sublingual, parenteral, subcutaneous,intravenous, intramuscular, intraperitoneal, intrapleural, intrathecal,transdermal, transmucosal, rectal, and the like). For example, apharmaceutical composition of the disclosure may be in the form of anaqueous solution or powder for aerosol administration by inhalation orinsufflation (either through the mouth or the nose), in the form of atablet or capsule for oral administration; in the form of a sterileaqueous solution or dispersion suitable for administration by eitherdirect injection or by addition to sterile infusion fluids forintravenous infusion; or in the form of a lotion, cream, foam, patch,suspension, solution, or suppository for transdermal or transmucosaladministration.

A pharmaceutical composition can be in the form of an orally acceptabledosage form including, but not limited to, capsules, tablets, buccalforms, troches, lozenges, and oral liquids in the form of emulsions,aqueous suspensions, dispersions or solutions. Capsules may containmixtures of a compound of the present disclosure with inert fillersand/or diluents such as the pharmaceutically acceptable starches (e.g.,corn, potato or tapioca starch), sugars, artificial sweetening agents,powdered celluloses, such as crystalline and microcrystallinecelluloses, flours, gelatins, gums, etc. In the case of tablets for oraluse, carriers which are commonly used include lactose and corn starch.Lubricating agents, such as magnesium stearate, can also be added. Fororal administration in a capsule form, useful diluents include lactoseand dried corn starch. When aqueous suspensions and/or emulsions areadministered orally, the compound of the present disclosure may besuspended or dissolved in an oily phase is combined with emulsifyingand/or suspending agents. If desired, certain sweetening and/orflavoring and/or coloring agents may be added.

A pharmaceutical composition can be in the form of a tablet. The tabletcan comprise a unit dosage of a compound of the present disclosuretogether with an inert diluent or carrier such as a sugar or sugaralcohol, for example lactose, sucrose, sorbitol or mannitol. The tabletcan further comprise a non-sugar derived diluent such as sodiumcarbonate, calcium phosphate, calcium carbonate, or a cellulose orderivative thereof such as methyl cellulose, ethyl cellulose,hydroxypropyl methyl cellulose, and starches such as corn starch. Thetablet can further comprise binding and granulating agents such aspolyvinylpyrrolidone, disintegrants (e.g. swellable crosslinked polymerssuch as crosslinked carboxymethylcellulose), lubricating agents (e.g.stearates), preservatives (e.g. parabens), antioxidants (e.g. BHT),buffering agents (for example phosphate or citrate buffers), andeffervescent agents such as citrate/bicarbonate mixtures.

The tablet can be a coated tablet. The coating can be a protective filmcoating (e.g. a wax or varnish) or a coating designed to control therelease of the active agent, for example a delayed release (release ofthe active after a predetermined lag time following ingestion) orrelease at a particular location in the gastrointestinal tract. Thelatter can be achieved, for example, using enteric film coatings such asthose sold under the brand name Eudragit®.

Tablet formulations may be made by conventional compression, wetgranulation or dry granulation methods and utilize pharmaceuticallyacceptable diluents, binding agents, lubricants, disintegrants, surfacemodifying agents (including surfactants), suspending or stabilizingagents, including, but not limited to, magnesium stearate, stearic acid,talc, sodium lauryl sulfate, microcrystalline cellulose,carboxymethylcellulose calcium, polyvinylpyrrolidone, gelatin, alginicacid, acacia gum, xanthan gum, sodium citrate, complex silicates,calcium carbonate, glycine, dextrin, sucrose, sorbitol, dicalciumphosphate, calcium sulfate, lactose, kaolin, mannitol, sodium chloride,talc, dry starches and powdered sugar. Preferred surface modifyingagents include nonionic and anionic surface modifying agents.Representative examples of surface modifying agents include, but are notlimited to, poloxamer 188, benzalkonium chloride, calcium stearate,cetostearyl alcohol, cetomacrogol emulsifying wax, sorbitan esters,colloidal silicon dioxide, phosphates, sodium dodecylsulfate, magnesiumaluminum silicate, and triethanolamine.

A pharmaceutical composition can be in the form of a hard or softgelatin capsule. In accordance with this formulation, the compound ofthe present disclosure may be in a solid, semi-solid, or liquid form.

A pharmaceutical composition can be in the form of a sterile aqueoussolution or dispersion suitable for parenteral administration. The termparenteral as used herein includes subcutaneous, intracutaneous,intravenous, intramuscular, intra-articular, intraarterial,intrasynovial, intrasternal, intrathecal, intralesional and intracranialinjection or infusion techniques.

A pharmaceutical composition can be in the form of a sterile aqueoussolution or dispersion suitable for administration by either directinjection or by addition to sterile infusion fluids for intravenousinfusion, and comprises a solvent or dispersion medium containing,water, ethanol, a polyol (e.g., glycerol, propylene glycol and liquidpolyethylene glycol), suitable mixtures thereof, or one or morevegetable oils. Solutions or suspensions of the compound of the presentdisclosure as a free base or pharmacologically acceptable salt can beprepared in water suitably mixed with a surfactant. Examples of suitablesurfactants are given below. Dispersions can also be prepared, forexample, in glycerol, liquid polyethylene glycols and mixtures of thesame in oils.

The pharmaceutical compositions for use in the methods of the presentdisclosure can further comprise one or more additives in addition to anycarrier or diluent (such as lactose or mannitol) that is present in theformulation. The one or more additives can comprise or consist of one ormore surfactants. Surfactants typically have one or more long aliphaticchains such as fatty acids which enables them to insert directly intothe lipid structures of cells to enhance drug penetration andabsorption. An empirical parameter commonly used to characterize therelative hydrophilicity and hydrophobicity of surfactants is thehydrophilic-lipophilic balance (“HLB” value). Surfactants with lower HLBvalues are more hydrophobic, and have greater solubility in oils, whilesurfactants with higher HLB values are more hydrophilic, and havegreater solubility in aqueous solutions. Thus, hydrophilic surfactantsare generally considered to be those compounds having an HLB valuegreater than about 10, and hydrophobic surfactants are generally thosehaving an HLB value less than about 10. However, these HLB values aremerely a guide since for many surfactants, the HLB values can differ byas much as about 8 HLB units, depending upon the empirical method chosento determine the HLB value.

Among the surfactants for use in the compositions of the disclosure arepolyethylene glycol (PEG)-fatty acids and PEG-fatty acid mono anddiesters, PEG glycerol esters, alcohol-oil transesterification products,polyglyceryl fatty acids, propylene glycol fatty acid esters, sterol andsterol derivatives, polyethylene glycol sorbitan fatty acid esters,polyethylene glycol alkyl ethers, sugar and its derivatives,polyethylene glycol alkyl phenols, polyoxyethylene-polyoxypropylene(POE-POP) block copolymers, sorbitan fatty acid esters, ionicsurfactants, fat-soluble vitamins and their salts, water-solublevitamins and their amphiphilic derivatives, amino acids and their salts,and organic acids and their esters and anhydrides.

The present disclosure also provides packaging and kits comprisingpharmaceutical compositions for use in the methods of the presentdisclosure. The kit can comprise one or more containers selected fromthe group consisting of a bottle, a vial, an ampoule, a blister pack,and a syringe. The kit can further include one or more of instructionsfor use in treating and/or preventing a disease, condition or disorderof the present disclosure, one or more syringes, one or moreapplicators, or a sterile solution suitable for reconstituting apharmaceutical composition of the present disclosure.

All percentages and ratios used herein, unless otherwise indicated, areby weight. Other features and advantages of the present disclosure areapparent from the different examples. The provided examples illustratedifferent components and methodology useful in practicing the presentdisclosure. The examples do not limit the claimed disclosure. Based onthe present disclosure the skilled artisan can identify and employ othercomponents and methodology useful for practicing the present disclosure.

Example 1

In patients treated with apilimod there are alterations in variousproteins circulating in the blood plasma. One of these is GlycoproteinNonmetastatic Melanoma Protein B (GPNMB), a type I membrane proteinoriginally identified in melanoma cells. In addition to expression onthe cell surface, it can also be released (or shed) from cells by theactivity of matrix metalloproteases such as ADAM10 and ADAM12.

Expression of GPNMB increases significantly in the spinal cords ofpatients with ALS and this is accompanied by an increase in shed GPNMBin sera. A mouse model, which is based on the known mutation ofSuperoxide Dismutase 1 (SOD1^(G93A)) found in familial cases of ALSreplicates, many of the features of the human disease including theincrease in GPNMB. In this model, further increasing the levels of GPNMBprolongs survival, delays onset, and protects skeletal muscle fromdenervation and atrophy. The effects of GPNMB are likely mediatedthrough the extracellular, shed form of GPNMB, since the latter candirectly attenuate SOD1^(G93A) induced neural cell death in culture, asreported previously in Nagahara et al. (2016) J. Neuroscience.Neuroprotective effects have also been demonstrated in a mutanttransactive response DNA binding protein 43 kDa (TDP-43) cell culturemodel suggesting protection across ALS predisposing mutations.

Accordingly, we investigated whether apilimod treatment in humansincreased the levels of shed GPNMB.

A SOMAscan™ platform was used to identify analytes that were changed inthe plasma of patients upon apilimod dosing. SOMAscan™ is anaptamer-based proteomics assay from SomaLogic capable of measuring 1,305human protein analytes in serum or plasma with high sensitivity andspecificity. Plasma from patients enrolled in the clinical trialdesignated NCT02594384 was collected pre-dose (before the firstadministration of apilimod) and after 14 days of dosing with apilimod,on day 15. Using differential protein analysis with a pairedexperimental design for linear models of microarray data using the“Limma R” software package described by Ritchie et al. in Nucleic AcidsResearch, 43(7), pp. e47 (2015).

GPNMB was identified as the analyte that showed the highest average foldchange (4-fold) among the analytes that were significantly changed(FDR<0.05) (FIG. 1). Thus, apilimod dosing consistently increased theplasma levels of GPNMB in treated patients. These results indicate thatapilimod treatment may ameliorate the neuromuscular degradation found inALS, and potentially improve patient survival. In addition, sinceriluzole is the current standard of care treatment for ALS, weanticipate that combination therapy with apilimod and riluzole willprovide significant improvements in the treatment of ALS compared toeither apilimod or riluzole therapy alone.

What is claimed is:
 1. A method for treating a neurological disease ordisorder in a subject in need thereof, the method comprisingadministering to the subject a pharmaceutical composition comprisingapilimod, or a pharmaceutically acceptable salt thereof, in combinationwith a glutamatergic agent.
 2. The method of claim 1, wherein theapilimod is apilimod dimesylate.
 3. The method of claim 1, wherein theglutamatergic agent is selected from a glutamate transporter modulatingagent and a glutamate receptor antagonist.
 4. The method of claim 3,wherein the glutamate transporter modulating agent is an excitatoryamino acid reuptake inhibitor.
 5. The method of claim 3, wherein theglutamate receptor antagonist is an N-methyl-D-aspartate (NMDA) receptorantagonist.
 6. The method of claim 3, wherein the glutamate receptorantagonist is selected from AP5 (R-2-amino-5-phosphonopentanoate), AP7(2-amino-7-phosphonoheptanoic acid), CNQX(6-cyano-7-nitroquinoxaline-2,3-dione), CPPene(3-[(R)-2-carboxypiperazin-4-yl]-prop-2-enyl-1-phosphonic acid), NBQX(2,3-dihydroxy-6-nitro-7-sulfamoyl-benzo[f]quinoxaline-2,3-dione), andselfotel (CGS-19755).
 7. The method of claim 3, wherein the glutamatereceptor antagonist is selected from amantadine, atomoxetine, AZD6765,agmatine, gacyclidine, ketamine, memantine, eliprodil, delucemin.
 8. Themethod of claim 1, wherein the glutamatergic agent is selected fromBHV-5000, lamotrigine, lanicemine, riluzole, trigriluzole, andtopiramate.
 9. The method of claim 1, wherein the pharmaceuticalcomposition is an oral dosage form or a sublingual dosage form.
 10. Themethod of claim 1, wherein the glutamatergic agent is administered inthe same or a different dosage form as the apilimod.
 11. The method ofclaim 1, wherein the neurological disease or disorder is selected fromAlzheimer's disease, amyotrophic lateral sclerosis (ALS), attentiondeficit hyperactivity disorder, autism, cerebellar ataxia,Charcot-Marie-Tooth disease, Creutzfeldt-Jakob disease, dementia,epilepsy, Friedreich's ataxia, Huntington's disease, multiple sclerosis,obsessive compulsive disorder (OCD), Parkinson's disease, Rett syndrome,senile chorea, spinal ataxia, spinal cord injury, supranuclear palsy,traumatic brain injury.
 12. The method of claim 11, wherein theneurological disease or disorder is dementia.
 13. The method of claim12, wherein the dementia is selected from AIDS dementia complex (ADC),dementia associated with Alzheimer's disease (AD), dementia pugilistica,diffuse Lewy body disease, frontotemporal dementia, mixed dementia,senile dementia of Lewy body type, and vascular dementia.
 14. The methodof claim 11, wherein the neurological disease or disorder is amyotrophiclateral sclerosis (ALS).
 15. The method of claim 11, wherein theneurological disease or disorder is Rett syndrome.
 16. The method ofclaim 11, wherein the neurological disease or disorder is obsessivecompulsive disorder (OCD).
 17. The method of claim 1, wherein thesubject is human.
 18. A method for treating amyotrophic lateralsclerosis (ALS) in a subject in need thereof, the method comprisingadministering to the subject a pharmaceutical composition comprisingapilimod, or a pharmaceutically acceptable salt thereof, in combinationwith a glutamatergic agent selected from riluzole and trigriluzole. 19.A method for treating Alzheimer's disease in a subject in need thereof,the method comprising administering to the subject a pharmaceuticalcomposition comprising apilimod, or a pharmaceutically acceptable saltthereof, in combination with a glutamatergic agent selected fromriluzole and trigriluzole.
 20. A method for treating obsessivecompulsive disorder (OCD) in a subject in need thereof, the methodcomprising administering to the subject a pharmaceutical compositioncomprising apilimod, or a pharmaceutically acceptable salt thereof, incombination with a glutamatergic agent selected from riluzole andtrigriluzole.
 21. A method for treating Rett syndrome in a subject inneed thereof, the method comprising administering to the subject apharmaceutical composition comprising apilimod, or a pharmaceuticallyacceptable salt thereof, in combination with a glutamatergic agentselected from BHV-5000, and lanicemine.
 22. A method of treating cancerin a subject in need thereof, the methods comprising administering tothe subject a pharmaceutical composition comprising apilimod, or apharmaceutically acceptable salt thereof, in combination with aglutamatergic agent selected from riluzole and trigriluzole, wherein thecancer is selected from brain cancer, breast cancer, cervical cancer,colorectal cancer, leukemia, lung cancer, lymphoma, melanoma or otherskin cancer, ovarian cancer, prostate cancer, renal cancer, andtesticular cancer.
 23. A pharmaceutical composition comprising apilimodand a glutamatergic agent, and a pharmaceutically carrier.
 24. Thepharmaceutical composition of claim 23, wherein the apilimod is apilimoddimesylate.
 25. The pharmaceutical composition of claim 23, wherein theglutamatergic agent is selected from a glutamate transporter modulatingagent and a glutamate receptor antagonist.
 26. The pharmaceuticalcomposition of claim 25, wherein the glutamate transporter modulatingagent is an excitatory amino acid reuptake inhibitor.
 27. Thepharmaceutical composition of claim 25, wherein the glutamate receptorantagonist is an N-methyl-D-aspartate (NMDA) receptor antagonist. 28.The pharmaceutical composition of claim 25, wherein the glutamatereceptor antagonist is selected from amantadine, atomoxetine, AZD6765,agmatine, gacyclidine, memantine, eliprodil, delucemin.
 29. Thepharmaceutical composition of claim 23, wherein the glutamatergic agentis selected from riluzole, trigriluzole, BHV-5000, and lanicemine. 30.The method of claim 22, wherein the glutamatergic agent is trigriluzole.